Mental Health And Substance Abuse

What is Anosognosia in Mental Illness?

Jim Sugel on July 10, 2024

Today, millions of Americans struggle with mental health problems ranging from substance abuse to anxiety or depression to bipolar disorder or schizophrenia. With almost 1 in 4 Americans qualifying for a mental health diagnosis of some kind, it’s incredibly normal to have a mental illness or mental health problem. But, for some of us, realizing that we have those problems is part of the mental illness. Instead, a percentage of people suffer from a condition known as Anosognosia, in which they are unable to realize or recognize that they have a mental health problem.

While this can be linked to denial, anosognosia is an illness of its own and is characterized by damage to the brain, which can result from bipolar disorder, schizophrenia, Alzheimer’s, dementia, some kinds of trauma, and traumatic brain injury.

What is Anosognosia?

Anosognosia is a condition in which you cannot recognize another or other health conditions that you have. For most people, it means you simply are not aware of a deficit or illness that you have and instead see yourself as normally functioning and not in need of medication or help. In mental illness, it most often crops up in bipolar disorder and schizophrenia, where affected individuals may think they are normally functioning and not in need of any help at all. However, the illness is from a family of agnosia’s, all of which relate to inability to recognize sensory input. For example, the inability to see visual motion, inability to recognize body parts, inability to recognize partial paralysis, inability to differentiate visual objects, etc.

In mental illness, anosognosia is most-often linked to bipolar disorder and schizophrenia. Here, individuals can suffer significant trauma to the brain, resulting in their inability to see that they are functioning any differently than the people around them. They may also not notice or not realize that episodes happen and may therefore feel that any attempts to get them help are trying to harm them or asking them to do something for no reason.

What’s the Difference Between Anosognosia and Denial?

There are significant overlaps between anosognosia and denial. People who are in denial of having a mental health condition can delude themselves to the point of very significantly believing that they don’t have a problem.

Denial can also be a significant mental health problem in which a person can delude themselves into a condition that can be diagnosed as anosognosia. If you are incapable of acknowledging that you have a deficit, whether because of brain injury or because of a mental health problem, it likely qualifies as anosognosia.

Anosognosia is normally linked to the mechanism by which people make a mental image of themselves. Here, you have to change that mental image as you move through your life. You get a haircut, now you have to think of yourself with short hair. You learn a new skill, your mental image of yourself updates to include being able to achieve tasks with that skill. But when you lose skills, it can be difficult for your brain to adapt. You see this with people who lose limbs who very often react and try to use those limbs for decades after losing them. For example, patients with amputated limbs show brain activity for those amputated limbs decades after amputation, because the brain never gets rid of the portion of the brain dedicated to moving that limb.

Mental illness is thought to have a similar mechanism, where persons who lose functionality, such as by going into a bipolar manic episode, are unable to recognize the episode because their brain isn’t updating their mental image. The brain is inflexible. Whether that’s caused by brain chemistry, denial, or traumatic injury to the brain is less relevant than the fact that the problem exists.

Anosognosia can be a form of denial. It might also be something forced on the individual by a brain injury. You can’t just talk someone with anosognosia out of it. If that were the case, they would just have denial and not anosognosia.

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Who Develops Anosognosia?

Anosognosia is extremely rare on a population level but extremely common when you start to look at the specific groups that it affects. For example, one study shows that it impacts an estimated 40% of people with bipolar disorder, 40-98% of persons with schizophrenia, and 20-80% of persons with Alzheimer’s.

Often, anosognosia follows significant trauma to the brain, which can occur as a result of a mental health disorder like schizophrenia.

Signs & Symptoms of Anosognosia

Anosognosia is characterized by an inability to recognize that something is wrong. That can mean:

The individual stops taking their meds
The individual goes from understanding they have a diagnosis to claiming they are completely healthy and potentially back again (Anosognosia can come and go)
The individual is paranoid about why people want them to get treatment or take medications
The individual deteriorates and starts having worse symptoms of mental health problems becuase they stop taking care of themselves and going to treatment (after all, nothing is wrong).

Diagnosing anosognosia normally starts with a questionnaire to assess whether someone is aware of having problems. The Scale to Assess Unawareness of Mental Disorder (SUMD) is the standard used here. After this, you may receive a CT, EEG, or MRI scan to check for physical damage to the brain. Often, there are no physical signs, especially in patients with schizophrenia and bipolar disorder.

How Do You Treat Anosognosia?

Anosognosia can be extremely difficult to treat because people receiving treatment are often resistant to treatment. For this reason, it’s best to take a mixed approach of switching away from getting someone to acknowledge illness and towards getting someone to acknowledge goals.

For example, in patients with schizophrenia, getting them to take medication is often the primary goal. About a third of persons with schizophrenia-related anosognosia are able to recognize that they have mental health problems when they take their medication long enough for it to have an effect.

Motivational enhancement therapy is also often used to help people meet goals like going to treatment and taking medication. Again, the goal is not to convince the person that they are ill or that they have a diagnosis. Instead, it’s to convince them that there are benefits to fixing a specific behavior or making a change and then getting them to do it – to improve their overall wellbeing. In patients with “denial” MET is used to convince people that they have a mental illness and need treatment, but this approach does not work with anosognosia.

Getting Help

People with anosognosia are unable to acknowledge that they have a mental health problem. This may be total (they never realize they have a mental health problem) or it may come and go (they take meds for months and then suddenly believe they are well and are taking medication for no reason). In every case, the best approach is to get that person to a doctor where they can be diagnosed and given treatment. Often, the challenge is keeping that person in treatment because they won’t normally see anything wrong with themselves. That means talking to them about goals like work, living alone, taking care of themselves, etc., and then working out reasons that mental health professionals can help with that. You won’t get anywhere trying to talk someone with anosognosia into believing they are sick. However, you can talk them into getting help for other reasons by normalizing mental healthcare for normal life. Good luck getting treatment.

What Happens if You Leave Co-Occurring Disorders Untreated?

Jim Sugel on July 3, 2024

If you or a loved one has been diagnosed with a co-occurring disorder, you’re not alone. Today, 21.5 million Americans have both a substance use disorder and a mental health disorder. This means that you have a substance use disorder or addiction and a behavioral or mental health disorder like bipolar disorder, depression, anxiety, or schizophrenia.

This overlap in diagnosis happens for a wide variety of reasons. For example, mental health disorders make you more vulnerable to dependence on substances and to addiction.

Addiction also triggers mental health disorders and can make them worse. For that reason, it’s important to treat both at the same time, with a treatment program designed around the needs of your co-occurring disorder.

If that doesn’t happen, you could find yourself relapsing.

Co-Occurring Disorders Get in the Way of Treatment

If you go to an addiction treatment program built around the needs of a dual diagnosis patient, the treatment is designed to treat the most pressing issues first. That means it will tackle physical reliance on the substance, and behaviors that present a risk to mental and physical health, and then start on treating behaviors and attitudes that get in the way of treatment.

That means:

Treating mental health problems that delay or prevent treatment
Tackling behavior and mindset
Working on improving motivation for treatment
Creating the mental health to allow the individual to adapt and respond to treatment

How does that work? If you’re completely overwhelmed by anxiety or depression, or in the middle of a manic episode because of bipolar disorder, you don’t have the resources to concentrate on therapy or to make meaningful steps to change. This means that it will be crucial to recognize where you’re at and what your capabilities are and then use treatment to bring you to a point where you can benefit from addiction treatment and therapy.

Co-Occurring Disorders Increase Risk of Relapse

Mental health disorders increase your risk of drug abuse and addiction. They also increase your risk of relapse. Why? You’ll still be dealing with stress and anxiety caused by the mental health disorder. In addition, it’s highly likely that you won’t have had the same benefit from therapy and treatment that you would have if you didn’t have the co-occurring disorder.

Persons with mental health disorders are significantly more likely to use drugs and alcohol. That tracks to self-medication, where you use drugs and alcohol to feel better or to reduce stress. It also tracks to impulsivity, poor risk assessment for decision-making, and increased chemical reliance on drugs and alcohol. That’s especially true if you have a mental health disorder that reduces serotonin production in the brain, because drinking or using drugs can temporarily make you feel much better than you do normally, so you’re much more likely to continue using.

Failing to treat these issues mean you remain vulnerable to relapse because you:

Are still under a high amount of stress
Haven’t actually changed your behavior, only quit drinking or using
Haven’t benefited from treatment because mental health disorders were in the way

This often means that as soon as something goes wrong or stress levels get too high, you’re very likely to relapse and start using again. That’s worse with disorders like bipolar disorder, where you’re very likely to relapse as soon as mania strikes again.

What’s worse, relapsing often increases your chances of negative outcomes. For example, if you use drugs, your tolerance to the drug will have decreased, meaning that the same dose that was safe for you before may be dangerous now. Relapsing also means massive setbacks in progress and needing treatment again, but first you have to make it through it and choose to go back to treatment.

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Co-Occurring Disorders Decrease Quality of Life

Untreated mental health disorders can significantly impact quality of life. That often means you’ll be dealing with mental health problems like anxiety, depression, feeling down, and low energy – all while being asked to work on high-maintenance self-care and self-improvement routines.

For example, people with mental health disorders often experience symptoms like:

Social isolation
Engaging in risky behaviors
Poor personal hygiene and self-care
Poor nutritional habits
Sleeping too much / too little
Excessive stress or anxiety in response to situations

At the same time, you’ll be asked to:

Maintain a consistent social schedule
Create consistent routines to clean your home
Exercise most days
Eat healthy food most days
Sleep in consistent and routine blocks

If those sound like they might be contradictory, you’re not wrong. Mental health problems actively get in the way of the routines and habits you need to live a healthy life that supports recovery. Of course, if you can maintain those habits, they will also help with mental health problems. However, doing so often means getting treatment for the mental health problems that are getting in the way.

You’ll Still Be Dealing with the Same Stuff

Chances are that you started drinking or using for a reason. Chances are also very high that your mental health disorder was a large part of that. For many people, substance abuse is about self-medication, dealing with problems, and escaping from problems. If your mental health disorder actively interferes with your relationships, makes you feel bad, causes anxiety, or prevents you from doing the things you want to do in the ways you want to do them, then your mental health disorder is likely at least partially behind why you started drinking or using in the first place.

If you don’t actively treat your mental health disorder as part of dual diagnosis treatment, you’ll go back to your life, dealing with the same problems that sent you to rehab in the first place. That probably sounds like setting yourself up for failure, because it is. If you want to recover, you need to be able to change the underlying causes behind relying on drugs and alcohol, and that means treating mental health disorders, getting help with symptom management, and getting a prescription for medication where you need it. All of that means looking into a co-occurring disorder program where you can get help with both at the same time.

Getting Help for a Dual Diagnosis

Treating a mental health disorder means having space to change your behavior and your life outlook. Sometimes it means getting medication and treatment. At the same time, you’ll have to treat a substance use disorder at the same time, because aspects of a substance use disorder can get in the way of treatment. However, once you get over the initial barrier of needing to be clean and sober and motivated, you’ll often find that many of the tools for mental health treatment help with recovery and vice-versa. That means you’ll have treatment for mental health that contributes to your recovery and structure for recovery that contributes to mental health. So, while co-occurring disorders can get in the way of recovery, once you get started, treating both at the same time just makes sense.

If you need help, it’s important to talk to your doctor, be upfront about any mental health disorders or diagnoses, and get the full help you need – for both mental health problems and substance use disorder, even if you don’t yet have a diagnosis for both.

The Link Between Cannabis Use and Schizophrenia

Andrea Wagner on November 21, 2023

Cannabis is one of the most frequently used drugs in the United States, with an estimated 18.7% of the U.S. population using at least occasionally. That’s more than 52.5 million people. Cannabis and marijuana are more and more often accepted as a relatively safe drug for medical and recreational use. Yet, heavy use is also more and more often linked to behavioral health disorders like schizophrenia and paranoia. Schizophrenia is a complex mental health disorder linked to genetics, but research shows that cannabis use could trigger dormant schizophrenia. For that reason, it’s important that you be aware of the risks and how they might affect you or your loved one before using.

This doesn’t mean that cannabis can immediately trigger schizophrenia the first time you use. Instead, the relationship is likely complex, related to heavy use, and heavily dependent on genetics. For many people, cannabis only increases the risk of receiving a cannabis diagnosis. That does mean that understanding the risks will contribute to your ability to use safely.

How does Cannabis Contribute to Schizophrenia

Cannabis is widely regarded as increasing vulnerability to schizophrenia. Often, that means the individual had an underlying but dormant schizophrenic disorder. It’s not yet known if cannabis can cause schizophrenia in a person without genetic inclination for the disorder, but it is thought that the answer is no. This means that genetics play a very large role in cannabis contributing to schizophrenia.

Increased Risk of Psychosis – Most people are aware that if you smoke too much cannabis, you get paranoid. Even if you’ve never smoked, everyone has seen the friend being paranoid. Even that mild psychosis can contribute to schizophrenia. In fact, paranoia is one of the first symptoms of schizophrenia, with one study of over 15,600 participants showing that people who experience paranoia when smoking cannabis are at an increased risk of developing schizophrenia than those that don’t experience paranoia when smoking cannabis.
Poor Coping Mechanisms – People who smoke cannabis often do so to self-medicate and to alleviate existing symptoms and mental health problems. That can be using cannabis to relax. It can also mean using cannabis to treat early symptoms of schizophrenia instead of getting help for them.
Genetic Triggers – Some research shows that people with certain gene expressions will have an increased likelihood of a schizophrenia diagnosis after smoking cannabis. These currently include AKT1 C/C and COMT gene expressions, both of which increase the psychotomimetic effects of cannabis. Essentially, persons with those genes experience more psychosis than individuals without those gene expressions, which can mean a higher risk of schizophrenia – or that those genes are linked to underlying schizophrenia already being there.

Cannabis Increases Your Likelihood of a Schizophrenia Diagnosis

Today, it’s estimated that some 0.5-1% of the population has schizophrenia and that more than 3% of the population are vulnerable to schizophrenia. This means that 3% or more of the population carry all of the risk factors for schizophrenia, or what is otherwise known as “Dormant” schizophrenia.

However, studies that take individuals with high risks based on genetics show that individuals who smoke cannabis and have genetic risks are 40% more likely to receive a diagnosis than those that do not. Of course, that could also be related to a mix of factors such as:

Persons experiencing schizophrenia symptoms are more likely to self-medicate
Individuals with schizophrenia are more likely to take risks (e.g., drugs)
People who smoke cannabis are more likely to be from low-income homes and unable to receive proper mental health treatment

While it’s likely to be a combination of everything, multiple studies show that individuals who smoke cannabis are typically diagnosed with schizophrenia as early as 2.8 years sooner than family members with the same background and risks who do not smoke cannabis.

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What are Known Risk Factors?

There are plenty of risk factors that can contribute to your likelihood of a schizophrenia diagnosis related to cannabis usage. The following include some of the most common:

Gender – Men are both more likely to smoke cannabis and more likely to receive a schizophrenia diagnosis
Age of Usage – If you begin using cannabis before the age of 25, it may increase the risks of schizophrenia at a later age. That’s linked to the fact that the brain is more plastic and in development under the age of 25, meaning that changes to dopamine and serotonin regulation by cannabis are more likely to become permanent functions of how the brain works. This also means that reducing risks means waiting to smoke until after the age of 25. However, young adults aged 18-35 make up the most statistically significant population of cannabis users.
Amount of Usage – The more you smoke, the more you are at risk of developing complications, including psychosis. For example, studies show that even smoking a single joint per week can develop schizophrenia at a later date – although causation and correlation are still in question. On the other hand, the people most likely to receive a diagnosis are those who qualify as heavy users, or who smoke on average once or more per day.
Genetics – Genetics are still the most important trigger in a schizophrenia diagnosis. For example, individuals with the gene expression AKT 1 C/C are 7 times more likely to receive a schizophrenia diagnosis after heavy cannabis usage than those without the gene expression, even with comparable cannabis consumption. However, if you have the AKT 1 C/C gene expression, you’re more likely than a non-C/C expression person to receive a schizophrenia diagnosis, even if you don’t smoke cannabis. So, the gene is a risk and cannabis is only a trigger. This is also true with other genes, most notably COMT, which regulates how neurotransmitters like dopamine and serotonin are reabsorbed back into the brain.

It’s widely agreed that cannabis and schizophrenia interact a great deal. However, if you have a family history of schizophrenia, it’s significantly more likely to be the case.

So, what are the Risks?

If you have a family history of schizophrenia, it’s normally better to avoid psychosis-inducing drugs altogether. While they won’t “cause” schizophrenia, they can trigger it, bringing formerly dormant symptoms to the surface. Multiple studies indicate that cannabis can play a role in activating schizophrenia, meaning that you will be more likely to develop symptoms and to need a diagnosis. Therefore, it’s always a good idea to assess your medical history for the risk of schizophrenia before smoking. However, it’s also important to keep in mind that schizophrenia increases your risk of drug use and using cannabis to cope with symptoms. If you’re using, it’s a good idea to stop and evaluate why and to seek support and treatment for those symptoms.

In almost every case, there is a complex interplay between risks, factors, and triggers. You won’t develop schizophrenia because you smoked once. However, cannabis can and does contribute to an increase in psychosis, even if it seems mild. If you start experiencing paranoia, it’s a good first warning sign and a good reason to stop smoking and look for treatment.

Of course, most drugs are relatively safe in moderation. Still, many of us are “high risk”, meaning we take on extra risks of complications, triggering underlying problems, and even addiction when we use them. If that is you, it’s better to avoid smoking or using altogether.

Take the first step towards reclaiming control of your life by seeking help for cannabis addiction today. Contact our addiction treatment team today, we are here to support you on your journey to recovery.

The Link Between Hallucinogens and Suicide Risk

Andrea Wagner on October 26, 2023

Hallucinogens or psychedelics have a long history of being known for exacerbating mental health problems and increasing suicide risk. Today that’s come under question, especially as multiple studies show that hallucinogens may actually reduce risk of suicide in (previously) suicidal persons.

However, in both cases, we still need more data and a better understanding of how hallucinogens work on an individual level in order to make safe judgement calls.

In 2022, an estimated 49,449 Americans died of suicide. In 2012, 12.3 million adults seriously thought about suicide and 3.5 million adults made a plan to do so. Suicide dramatically impacts every aspect of our lives – so it’s important to understand the risks before you start taking drugs of any kind. Hallucinogens are no worse than any other drug, however, it is still critical that you be aware of the risks and that you have the information to use or make decisions safely.

Do Hallucinogens Increase Risk of Suicide?

The short answer is, there is no statistically significant data showing an increase in risk of suicide for persons who take hallucinogens. The long answer is that hallucinogens interact with the brain in complex ways and on an individual level, may be extremely harmful to mental health and stability, which may exacerbate or worsen existing mental health problems.

However, for the general population, hallucinogens show no direct correlation to an increase in risk of suicide. For example, a study profiling the hallucinogen usage of persons taking ayahuasca, a psychedelic drug used in religious rituals in the Amazon Rainforest, found no significant differences in mental health or mindset between persons who took the drug regularly for rituals. In fact, there were also no statistically significant differences between persons who started the study having used just once and those who had used 5+ times – and the study followed up on a yearly basis for two years. Instead, the only statistically significant differences were regular ayahuasca users were less likely to avoid dangerous or potentially harmful activities because they were less likely to worry about the results of those activities, were less likely to experience shyness, and were more likely to be dependent on getting to feel good out of an interaction or activity. With over 200 people profiled, there were no significant changes in mental health or in suicidal ideation or depression.

A similar study tracking the results of peyote on Native populations showed that 70,000 individuals using the drug were unlikely to experience statisticially different mental health norms than control groups not using the drugs.

People With Mental Health Problems Are More Likely to Use Drugs

While hallucinogens are unlikely to cause increases in risk of suicidal ideation or depression, people with suicidal ideation and depression are more likely to use drugs. This means that populations using hallucinogens are more likely to be vulnerable to suicide or suicidal ideation because they have a mental health disorder. That’s in part because many people use drugs and alcohol to self-medicate and to feel better. That’s especially true after multiple studies were picked up by the news showing that psychedelics can actually help people to relieve symptoms of suicidal ideation and decrease suicide risk. More people opt to self-medicate and then use psychedelics as a means of temporarily feeling better.

Self-medication is always dangerous because it means that people look for quick ways to feel better. This means they don’t treat underlying symptoms. Often, drug and alcohol use also exacerbates symptoms. Sometimes that’s by causing shifts in hormone and neurotransmitter production in the brain, reducing your ability to feel and process emotions properly or creating unhealthy reliance on drugs. Often, it also results in isolation and alienation from friends and family, pushing you further away from support networks and healthy coping mechanisms. That’s less true with psychedelics than with drugs like heroin or heavy alcohol use. However, hallucinogen use can still take the place of healthy coping mechanisms like exercise and eating well – resulting in reduced mental and physical health and worse coping mechanisms.

According to one study, almost 1 in 10 persons taking hallucinogens experienced major depressive episodes. However, the most significant factor contributing to those depressive episodes were significant trauma, typically before the age of 16. During the study, almost no one developed depressive episodes or suicidal ideation close enough to taking hallucinogens for the two to be linked. In fact, most people developed these episodes before taking hallucinogens with a smaller number of people developing them 3-5 years after starting hallucinogen use.

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Drugs and Alcohol Use Increase Risks of Suicide

That’s so much the case that drugs or alcohol were involved in 58.6% of all suicide deaths. Of those, alcohol is present in 22% – with severe intoxication being the number one most common factor between all people attempting suicide. That’s most likely linked to the fact that substance use and intoxication reduces inhibitions and decreases risk evaluation skills. This means people are more likely to be impulsive and less likely to be inhibited in their behavior. Therefore, if you go to drugs and alcohol while being depressed or suicidal, you’re more likely to go through with it while intoxicated. That lack of inhibition means that even a drug that doesn’t increase suicidal thoughts or behavior can increase the risk of suicide – because it means you’re less likely to weigh the negatives or to think through your decision. Drugs like hallucinogens also greatly reduce anxiety and ability to worry (although this depends on the specific drug) meaning that persons who take them score significantly lower on harm avoidance. This means that risk of suicide is higher while intoxicated, providing the individual was already experiencing suicidal ideation or depression.

Can Hallucinogens Decrease Risk of Suicide?

Multiple studies have shown that clinical hallucinogen use of either psylocibin or LSD can result in decreases in suicidal ideation in patients already showing suicide risk. However, it’s important to note that those studies are in a clinical setting with extremely controlled doses and reactions. For example, one study reviewing the efficacy of MDMA, psilocybin, and LSD in reducing suicidal thoughts and psychological distress found that MDMA and psilocybin reduced suicidal ideation by 0.01% to 10% over the course of the follow-up year. However, LSD increased risk of suicidal thoughts in that follow-up year. In addition, the study was not able to prove if results were because of hallucinogen usage or causal based on other lifestyle changes. Other studies show that LSD can also have a positive effect, although these studies are entirely clinical with controlled doses and settings.

Eventually, hallucinogens are like any other drug and should never be used to self-medicate. This means that it isn’t safe to use psychedelics of any kind to reduce suicidal ideation or depression, because you can’t guarantee what the outcome will be. Hallucinogens can increase risks of depression and psychosis in individuals, which can make your mental health problems worse. Therefore, you should never try to treat yourself with them outside of a clinical setting where you can get medical care, medical monitoring, and follow-up treatment if something goes wrong.

Hallucinogens have a reputation for increasing risk of suicide. However, that’s unlikely to be true. Instead, it’s more likely that people with a high risk of suicide are more likely to use drugs. In addition, drugs reduce inhibitions, which can increase risks of following through on suicide ideation. And, with more people now using hallucinogens to self-medicate, those risks are higher than ever. If you or a loved one is struggling with depression or thoughts of suicide, it’s important to seek out professional mental health help rather than attempting self-treatment.